Patient Care Week 5 Flashcards
Define surgical asepsis (sterilization)
Complete removal of all mo’s and their spores from the surfaces of any object using heat or chemicals
Prevents mo’s from entering body
Use when skin is penetrated
Where would an RT use surgical asepsis?
- surgery
- cardiovascular interventional procedures
- injections: (arthrograms, myelograms, etc.)
- catheterizations: urinary, coronary, etc.
- dressing changes
What are common causes of contamination?
- contaminated instruments or gloves
- allowing sterile field to become wet
- MO’s blowing into surgical site
Operating room
Designed to prevent MO’s from blowing into surgical suite
- ventilation ducts have filters
- OR has positive pressure
Autoclaving
Steam under pressure
• for items that can withstand high temperatures and moisture
• most commonly used method
• color indicators designate sterilization
Temp: 121 degrees C (250 degrees F)
Methods of sterilization
- autoclaving
- gas
- chemical sterilization
- dry heat
- ionizing radiation
Gas for sterilization
Mixture of ethylene oxide and co2
Heated to 57.3 degrees C ( 135 degrees F)
Humidity of 50%
- for items that cannot withstand heat
- takes too long- not preferred method
- gas penetrates porous materials
- objects must be allowed to air out
Chemical sterilization
Unsatisfactory- no way to insure sterilization
- uses activated gluteraldehyde
- immersion time is from 10-24 hours
Dry heat sterilization
Slow and uneven
Rarely used in hospitals
- for anhydrous oils, petroleum products and powders
- or for delicate surgical instruments
Ionizing radiation
Cobalt 60 is used
• used only in commercial sterilization and not in hospitals
Disinfection
Means that as many mo”s as possible are eliminated from surfaces by chemical or physical(friction) means
- note: different than sterilization
- spores are not killed
- uses agents known as disinfectants and antiseptics
Disinfectant agents
Strong chemicals used to clean inanimate objects
- tables, floors, walls, and equipment
- not for use on skin- chemicals too harsh
Antiseptic agents
A type of antibacterial agent safe for skin use on skin
- prevents mo’s from entering body through broken skin
- use when skin is to be penetrated
Chemicals in hospital use
In order to be acceptable, must protect against the following
- staphylococcus Aureus
- Salmonella Choleraesulis
- pseudomonas aeruginosa
Storage of sterile materials
Expiration dates are stamped on all materials
Storage areas must be clean, dust free and draft free
Stored in a closed cupboard or on a open shelf
What is the shelf life for items stored in a closed cupboard?
30 days
What is the shelf life for items stored on an open shelf?
21 days
What is the shelf life for items sealed in plastic bags immediately after sterilization?
6 to 12 months
The items are no longer considered sterile…
- if the seal is broken
- if package is damaged
- if expiration date has been exceeded
- if there is no expiration date
- if in doubt, throw it out
Rules for surgical Asepsis
A. know which areas and objects are sterile and which are not. Keep them separate
B. When contamination occurs, remedy immediately
C. Injections are considered sterile procedures(myelograms, arthrograms, arteriograms, etc)
D. If a table is to be used to support a sterile field, the table must be disinfected first, then a sterile drape is placed over it
E. if personnel are to be considered sterile, they must wear sterile gowns and sterile gloves
F. If an area on a sterile field has become contaminated, the area should be covered by a folded sterile towel or a drape of double thickness
G. If a sterile persons gown or gloves become contaminated, they must immediately change into clean ones
H. Never leave a sterile field unattended
I. If there is doubt about the sterility of an object, consider it contaminated
J. Never reach across a sterile field
K. Anything below the level of the tabletop or below waist level is considered unsterile
L. The only part of the gown considered sterile is the front, from the waist up, including the sleeves
M. Two sterile people must pass each other back to back, or front to front
N. sterile staff must stay in the sterile area
O. The edges of the sterile wrappers are not considered sterile, so they must not touch sterile objects
P. The sterile person faces the sterile field and keep gloved hands above the waist and in fron of the chest
Q. The sterile person touches only sterile objects
R. The sterile person does not lean on tables, walls, etc
S. an object that has become wet is considered contaminated
T. An object wet with bacteriiocides must first be placed on sterile towels to absorb excess moisture
U. Wet areas on the sterile field must be covered with several thicknesses of dry sterile toweling or drapes
V. All areas used for sterile procedure including floors, should be disinfected after each use
W. re-usable flasks containing sterile solution
• date it when opened (and time of day)
• open the lid face upward, and do not touch the inside of lid
• pour a small amount of solution as a discard before using
• after 24 hours, the sterile solution is no longer considered sterile
X. Before surgical scrub
• open first: gown, gloves, scrub sponges
• do you have sterile covers for cassettes and tube before starting?
• disinfect the table, x-ray equipment, etc
• film badge on? Scrubs? Cap? Mask?
• collect lead aprons if imaging during procedure (wear under sterile clothing)
When does an RT get involved in skin prep?
- procedures requiring skin puncture or incision
- applying or changing of sterile dressings
Examples:
- LP, for myelograms
- arterial catheterization
- any procedure where a needle, catheter or wire is inserted through the skin
What is the purpose of skin prep?
To remove or minimize as many of the skins MO’s as possible, thereby reducing the chance of infection
What are the methods of skin prep?
Mechanical
Chemical
Mechanical skin prep
Friction scrub with antiseptic soap and water
- hair removal sometimes necessary but most of the time not ( no on tests)
- not possible to sterilize the skin
- with proper technique, good degree of mo dilution is possible
What equipment is used for mechanical skin prep?
- prep kit (gloves, sponge, soap, gauze, basin)
- towels or chux
- chlora prep
Things to remember when doing mechanical skin prep
- wash hands
- explain procedure to patient, and place him/her in a comfortable position
- drape to protect modestly and keep warm
- prep area 6-10” (physician will specify size)
- scrub firmly in a circular motion
- scrub 3-10 minutes (w/lodophor detergent) depending on size of the body part
- dont rinse off, but wipe from center out with sterile gauze or blue towel
- inspect skin
Chemical skin prep
- used after mechanical prep
- uses chemicals to destroy mo’s
- providine-iodine solution
Chemical procedure for skin prep
- paint in circular motion, working outward from center
* repeat
Precautions with chemical skin prep
- dont go over area previously prepped
* ask about allergies prior to prep
Procedure for removing dressing
- prepare equipment
- wash hands and put on gloves
- prep pt., protect modesty and keep warm
- loosen tape
- support skin with hand
- dispose of dressing
- wash hands after disposing gloves
EQUIPMENT FOR APPLYING A STERILE DRESSING
- sterile towel
- gauze pads
- tape
- biohazard receptacle for refuse
- sterile gloves
To apply sterile dressing
Rule: layer of four thicknesses extending 2” beyond the wound on all sides
Dressing should be left in place and not moved
Procedure for applying sterile dressing
- wash hands
- explain exam to patient to prepare them
- use sterile towel as sterile field
- place dressings on towel
- cut tape
- put on sterile gloves
- apply dressing (extra if draining) and tape it
- remove gloves
- wash hands
Isolation technique
The CDC calls this
Transmission-based precautions
Isolation
A technique used for people with communicable diseases to control the spread of pathogenic microorganisms from one person to another
Where and why isolation?
Used in patients room or in the medical imaging department
Failure can result in infecting self, co-workers, or other patients (nosocomial infections-HAI)
Direct contact (vectors)
Diseases that may be transmitted this way are?
- Mononucleosis - affects lymphoid tissue
- Hepatitis A- spread by feces/food/water
- syphilis- venereal disease
- gonorrhea- venereal disease
- rabies- affects CNS, paralysis and death
- scarlet fever- rash caused by strep
- staphylococcal infections- staph infection
- herpes simplex- oral or genital herpes
- meningococcal meningitis- bacteria in blood; infects membranes of brain and cord
Vectors
Rocky mountain spotted fever
- parasite in red blood cells
Malaria
- parasite in red blood cells
Typhus
- obtained by rickettsia
Indirect routes
- droplet(flu, pneumonia, diphtheria)
- fomites ( inanimate objects)
- airborne (TB and Rubeola)
Droplet (i.e. Coughing, sneezing)
- meningitis
- measles- maculopapular eruption
- chicken pox
- pneumonia
- influenza
- colds
- mumps
Fomites
Typhoid fever- lesions in mesenteric glands and spleen
Salmonella- food poisoning
Bacillary dysentery- bacteria in the intestines
Hepatitis B- infection from bodily fluids
Airborne
Influenza
Coccidioidomycosis- mostly respiratory organs
Histoplasmosis- fungal respiratory disease
Types of isolation
Category specific isolation
- airborne and contact- cannot share a room)
Disease specific isolation
- chicken pox- can share a room
Now called transmission based
Wound and skin precautions
Isolation used where direct contact may spread an infection
Minor burns, gangrene, staph infections, strep infection wounds, decubitus ulcer, conjunctivitis, abscess, etc.
Precautions
Private room
Gown
Gloves
Hand-washing before and after contact
Any articles used must be isolated also
Respiratory
Used where the disease may be spread by droplet or airborne routes
- chicken pox
- herpes zoster
- measles
- meningococcal meningitis
- mumps
- TB
- pertussis (whooping cough)
- influenza
- meningococcal pneumonia, etc
Contact isolation
Used to prevent transmission of disease
Spread by direct contact or indirect contact
Some diseases for contact isolation use
- acute respiratory infections (infants and young children)
- impetigo (inflammatory skin disease)
- herpes simplex
- influenza
- pediculosis (lice)
- scabies
- wound care
- burn infection
Enteric isolation
Used where the disease may be transmitted directly or indirectly with contaminated feces
- c-diff: clostridium difficile
- norovirus
- rotovirus
Protective isolation/reverse isolation
To protect the patient from becoming infected
- burn victims
- leukemia
- lymphoma
- patients whose skin is denuded to injury from disease
- immunosuppressive therapy
- infants in critical care nursery
- aids, etc
Psychological considerations of reverse isolation
Explain you are protecting them from you and not the other way around
You do not want to infect them
What does it feel like to be in isolation?
AFB isolation- respiratory
Means acid fast bacilli
Tuberculosis
What is the cycle of infection?
Portal of entry Susceptible host Pathogenic organism Reservoir of infection Portal of exit Means of transmission
